With NMC taking over it may be time to revise MCI Code of Ethics (Part 3)

Dr KK Aggarwal

The MCI Code of Ethics Regulations requires a Declaration (Appendix 1) to be signed and submitted at the time of registration.

A. DECLARATION

1)    I solemnly pledge myself to consecrate my life to service of humanity.

2)    Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.

3)    I will maintain the utmost respect for human life from the time of conception.

4)    I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.

5)    I will practice my profession with conscience and dignity.

6)    The health of my patient will be my first consideration.

7)    I will respect the secrets which are confined in me.

8)    I will give to my teachers the respect and gratitude which is their due.

9)    I will maintain by all means in my power, the honour and noble traditions of medical profession.

10)  I will treat my colleagues with all respect and dignity.

11)  I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. I make these promises solemnly, freely and upon my honour.

Here is what the American Medical Association (AMA) has to say about professional responsibility and the Declaration.

Appendix D Declaration of Professional Responsibility 

Preamble:

Never in the history of human civilization has the well-being of each individual been so inextricably linked to that of every other. Plagues and pandemics respect no national borders in a world of global commerce and travel. Wars and acts of terrorism enlist innocents as combatants and mark civilians as targets. Advances in medical science and genetics, while promising great good, may also be harnessed as agents of evil. The unprecedented scope and immediacy of these universal challenges demand concerted action and response by all. As physicians, we are bound in our response by a common heritage of caring for the sick and the suffering. Through the centuries, individual physicians have fulfilled this obligation by applying their skills and knowledge competently, selflessly, and at times heroically. Today, our profession must reaffirm its historical commitment to combat natural and man-made assaults on the health and well-being of humankind. Only by acting together across geographic and ideological divides can we overcome such powerful threats. Humanity is our patient.

Declaration

We, the members of the world community of physicians, solemnly commit ourselves to:

1.     Respect human life and the dignity of every individual.

2.     Refrain from supporting or committing crimes against humanity and condemn all such acts.

3.     Treat the sick and injured with competence and compassion and without prejudice.

4.     Apply our knowledge and skills when needed, though doing so may put us at risk.

5.     Protect the privacy and confidentiality of those for whom we care and breach that confidence only when keeping it would seriously threaten their health and safety or that of others.

6.     Work freely with colleagues to discover, develop, and promote advances in medicine and public health that ameliorate suffering and contribute to human well-being.

7.     Educate the public polity about present and future threats to the health of humanity.

8.     Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.

9.     Teach and mentor those who follow us for they are the future of our caring profession.

We make these promises solemnly, freely, and upon our personal and professional honor.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

With NMC taking over it may be time to revise MCI Code of Ethics (Part 2)

Dr KK Aggarwal

Here is how the American Medical Association Principles of Medical Ethics changed from that issued in 1980 to that adopted in 2001.

Appendix B American Medical Association Principles of Medical Ethics (1980) 

Preamble

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

1. A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.
2. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.
3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
4. A physician shall respect the rights of patients, colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law.
5. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services.
7. A physician shall recognize a responsibility to participate in activities contributing to an improved community.

Appendix C American Medical Association Principles of Medical Ethics (2001) 

Preamble:

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
2. A physician shall uphold standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
4. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
5. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
7. A physician shall, recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX.A physician shall support access to medical care for all people.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Supreme Court to decide about apology: Will the Apex Court’s decision on apology have implications on medical mistakes?

Dr KK Aggarwal

Yesterday, the Congress president Rahul Gandhi expressed regrets in the Supreme Court over his remarks related to Rafaele.

If the Apex Court decides to accept the apology of Rahul Gandhi, this will provide another tool for councils to decide about medical apology.

The council has powers to accept the mistake. As per Regulation 8.2 of MCI Code of Ethics, “…If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate Medical Council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period, from the register of the name of the delinquent registered practitioner…”.

Apologies are gaining in importance, both nationally and internationally. These started with the example set by Pope John Paul II in his numerous apologies on behalf of the "children of the church" in anticipation of the Jubilee Year, as well as redress through national apologies to various groups-including Japanese Americans interned during World War II; Native Americans, whose land was confiscated and were otherwise mistreated; African Americans, whose ancestors were victims of slavery; and particular African Americans, who were victims of medical tests such as the "Tuskegee Experiment."

The importance of the apologies of healthcare professionals-particularly physicians and hospital leaders through their risk management personnel-to their patients for medical errors became an important matter in medical education and practice around 2000.

There have been at least five converging forces leading to the current interest in medical error apology.

1.     The physician-patient relationship is more egalitarian than ever before. Patients are now apt to be informed consumers-due in part to the Internet and popular advertising-who feel that they have the right to negotiate their treatment and know when mistakes have been made.

2.     The American medical community's knowledge about the frequency and seriousness of medical errors has been growing, and many believe that such knowledge and disclosure to patients will ultimately improve medical practice. Such disclosure is now required by the Joint Commission on Accreditation of Healthcare Organizations.

3.     Once doctors disclose a serious medical error to a patient, it is only common wisdom for medical professionals to apologize for psychological and humanitarian reasons. Patients would inevitably perceive withholding an apology in such circumstances as offensive, insensitive, and unprofessional.

4.     Physicians and other medical staff in several medical centers have successfully diminished the costs of malpractice suits by apologizing to patients for medical errors and, when appropriate, making out-of-court settlements.

5.     Several states in USA have passed or are considering legislation that would allow supportive, benevolent comments, as well as apologies, to be inadmissible in malpractice cases, thereby encouraging physicians to offer such comments and apologies.

Lawyers have always advised physicians and other healthcare professionals to refrain from apologizing to patients, because they believed that offering an apology is an admission of guilt, which would increase the frequency and amount of malpractice claims.

This assumption is changing and today many believe that such apologies are not only ethically correct but may even decrease such claims.

“Hushing up’ of errors increases results in an angry patient and creates distrust between the doctor and the patient. 

Apologize to the patient in such situations…While it does not undo the damage caused, an apology may soothe the emotions of the patient and/or the family and lessen the anger and distrust.

Let us see what the apex court decides…

(Source: De Paul University)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

What is Corporate Social Responsibility?

 Every corporate is responsible for some social or environmental cause.

The term Corporate Social Responsibility or CSR, as it is commonly known as, has been derived from the Vedas.

We all are aware of the commonly spoken maxim “Neki kar dariya me daal”. This means do your karma, forget about results. Do good and expect nothing. This is called “Nishkam Karma”.

It is now mandatory for all companies above a given defined size to spend 2% of their net profits of the last three financial years to charity (CSR activities) under Section 135 of the Indian Companies Act.

In Islam, all Muslims who meet the necessary criteria of wealth are required to give 2.5% of their total wealth to the needy as ‘Zakat’. Sikhism also requires Sikhs to donate one-tenth of their earnings as "Daan" towards the common resources of the community. 

The Gandhian principle of “Sarvodaya” or welfare of all advocates that the aim in life therefore should be to work not for oneself but for the welfare of the others. The basic fundamental teaching of the Vedic science is also based on sarvodaya. It talks about “bahujan hitay-bahujan sukhay” i.e. “the good of the masses, the benefit of the masses”.

“Vasudhaiva kutumbakam” i.e. the whole world is one family is derived from the Rig Veda and forms one of the fundamentals of Vedic philosophy.

It has been an IMA Policy that doctors should give 10% of their time to charity in the form of free OPDs or camps. Real charity is 100% free, but when corporates entered, this changed to “camps with conversion”. Charity has to be unconditional. Consultation alone should not be free. The entire treatment should be free and it should be transparent. Even the MCI Code of Ethics Regulations has said, “The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration (1.1.2).” 

A Devta is someone who gives and shares. Anybody who gives can be said to be a devta. Doctors can be likened to devtas, as they help the patient to heal.

All doctors do CSR. Every doctor is a “Trust” as he is a trustee of his patient.

This is why the medical profession is called a noble profession.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Don’t keep your patients waiting

Long waiting time influences patient satisfaction and physician ratings, according to findings from the 9th Annual Vitals Wait Time Report (https://www.vitals.com/about/posts/press-center/press-releases/9th-annual-vitals-wait-time-report-released).

·         84% patients considered waiting time to be “somewhat important” or “very important” part of the overall experience at the clinic.

·         30% patients walked out due to the long waiting time. The long delays also prompted patients to change their doctor; one in five patients reported changing their doctor as a result.

·         Doctors with the longest average wait time (34 minutes, 11 seconds) were rated lowest (one-star), while physicians with an average wait time of 13 minutes, 17 seconds were given a five-star rating.

This survey is a western study, where punctuality is given great importance, unlike in India, where people generally have a rather lax attitude towards punctuality.

But, punctuality is very important and no patient should be kept waiting, especially in an emergency. Regulation 3.3 of MCI Code of Ethics says, “Utmost punctuality should be observed by a physician in making themselves available for consultations”. A long waiting time negatively affects patient satisfaction.

Almost every patient carries a smartphone today and most patients now do not shy away from expressing their opinion about the quality of services on social media.

A satisfied patient is your best ‘advertisement’. A patient who is satisfied with the care received at your establishment will recommend you to 10 other potential patients, while an unsatisfied patient will talk against you to 100 people.

Punctuality denotes professionalism; it’s a trait worth having and adds value to your ‘brand’.

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA